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Kubler-Ross's Stages of Grieving:
Stages I-V
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Shock and disbelief
Denial
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May be expressed toward God, family, or providers of care.
Anger
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Asks God or fate for more time.
Bargaining
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With awareness of finality.
Depression
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Coming to terms with death.
Acceptance
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D
A
B
D
A
- D - Denial
- A - Anger
- B - Bargaining
- D - Depression
- A - Acceptance
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Maslow's Hierarchy of Needs and "losses"
Losses such as an amputation
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Maslow's Hierarchy of Needs and "losses"
Loss of a safe environment as with domestic violence
Safety
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Maslow's Hierarchy of Needs and "losses"
Loss of security and a sense of belonging such as...
loss of a loved one.
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Maslow's Hierarchy of Needs and "losses"
Loss of self esteem such as...
a change in how one is valued or perceived
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Maslow's Hierarchy of Needs and "losses"
Loss of self-actualization threats to...
goals and potentials.
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Length of grieving process:
One year.
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Time may vary and is defined as completed when:
The bereaved can remember (their loss) in a healthy context.
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Acute phase of grieving process typically lasts how long:
6-8 weeks.
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Factors that add to difficulty with grieving:
- Dependency issues
- Cumulative losses
- Loss of a young person
- Strained relationships
- Poor support systems
- Unexpected loss
- Bereaved person's state of health is poor or they feel "responsible"
- Violent death
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Beneficial factors in dealing with a loss:
- Intact support systems
- Strong role as caretaker of loved one before their death
- Preparation for the loss of anticipatory grieving.
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Typical physiological responses to grief:
- Insomnia
- Headaches
- Impaired appetitie
- Weight loss
- Lack of energy
- Palpitations
- Indigestion
- Changes in the immune and endocrine system
- Sleep disturbances (most common)
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Normal grieving may include:
- Feelings of sadnes, anxiety, guilt, and/or anger
- Thoughts of confusion, hopelessness and/or preoccupied.
- Oversensitive to stimuli
- Depersonalization
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Depersonalization is:
Feeling unreal or de-realization where they see or talk to the deceased.
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Grief over a loss that is not or cannot be acknowledged openly, mourned publicly, or supported socially.
Disenfranchised grief
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The relationship was not recognized or supported socially such as same-sex marriage, unmarried couples.
Disenfranchised grief
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The loss was not recognized such as prenatal death, loss of a pet, job loss, divorce, or placing a child for adoption.
Disenfranchised grief
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The griever is not recognized as in cases with nurses or other caregivers.
Disenfranchised grief
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Which type of grief is an unexpected response as outlined by prolonged periods of grieving or the grieving is disproportionate in intensity.
Complicated grieving
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The bereaved person remains fixed in the denial stage.
Delayed or inhibitied grief
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Instead of normal grieving the bereaved may avoid discussions about the deceased, immerse themselves in work, or immerse themselves in others problems.
Delayed or inhibited grief
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Their grief may be triggered spontaneously or with a subsequent loss - may see "overreaction to others losses"
Delayed or inhibited grief
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Causes may be ambivalence, poor resources, or trying to maintain "normal" appearances.
Delayed or inhibited grief
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All symptoms associated with grief are exaggerated.
Distorted (exaggerated) grief response
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The person is "dysfunctional" and often self-destructive.
Distorted (exaggerated) grief response
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The bereaved person remains in the anger stage.
Distorted (exaggerated) grief response
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Their anger may be toward others or turned inward.
Distorted (exaggerated) grief response
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This grief is difficult to assess but may be considered with behaviors.
Chronic or prolonged grief
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Maintains personal possessions aimed at keeping the lost one alive.
Chronic or prolonged grief
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Disabling behaviors prevent the bereaved from normal activities of daily living.
Chronic or prolonged grief
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Intense preoccupation with memories of the deceased
& Loss of self-identity
Chronic or prolonged grief
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Additional types of abnormal grieving:
- Absence of grieving
- Suicidal
- Self-neglect
- Drug and alcohol abuse
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General interventions for grieving patients:
- Facilitate their movement through the process
- Decrease their "negative" emotional symptoms
- Ensure that their physical and spiritual needs are met
- Promote independence
- Provide resources
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Normal VS. Maladaptive Grieving:
- Marked feelings of "worthlessness"
- Normal grief does not interfere with the bereaved person's self esteem
- Depression is identified when the bereaved person experiences guilt and worthlessness
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Usually with maladaptive grieving the patient may come out with a disorder/mental illness.
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Communication skills that are useful wit grieving patients:
- Refer to the loved one by name
- Simple and nonjudgemental
- Consider using therapeutic touch
- Be honest, consistent and trustworthy
- Don't expect to have all the answers
- Silence is effective in many cases
- Respect their unique form of grieving
- Respect their own personal beliefs
- Slow down and realize that this process takes time.
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The Patient and Family Value Directed Model of Care:
- Accepts grief and bereavement as normal
- Guides patients and families through life closure and completion tasks
- Uses primary prevention (avoiding complicated grief)
- Focuses on the survivor and uses a holistic approach
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Nurse's Role summarized:
- 1. Adequate perception regarding their loss
- 2. Adequate support while they are grieving
- 3. Adequate coping behaviors during the process.
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Self care issues:
- Nurses are exposed to death frequently and this could put them at risk for unresolved grief and bereavement overload.
- Recommended to use colleagues as one type of support system
- Person's with control issues and confrontational coping styles were at risk.
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Other self care issues:
- Watch for use of escape and avoidance strategies - consider professional help with necessary
- Consider alternative therapies such as journaling, exercise, yoga
- Encourage employers to establish quiet areas for staff to congregate and meditate. Request applicable in service training.
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